Heart failure (HF) is a chronic and debilitating condition affecting millions globally. Hospital readmission rates for HF patients are high, placing a significant burden on healthcare systems and impacting patient quality of life. This randomized controlled trial (RCT) aimed to evaluate the effectiveness of a nurse-driven discharge plan intervention (NDDPI) in reducing hospital readmission rates in patients with HF.

Introduction

HF is a complex clinical syndrome characterized by impaired cardiac function, leading to symptoms such as dyspnea, fatigue, and edema. Despite advancements in medical management, HF remains a leading cause of hospitalization and readmission, with readmission rates ranging from 15-30% within 30 days of discharge (Felton, 2019). These readmissions are associated with increased healthcare costs, decreased patient quality of life, and poorer long-term outcomes.

Numerous interventions have been implemented to reduce HF readmissions, with varying degrees of success. Nurse-driven discharge planning has emerged as a promising approach, leveraging nurses’ expertise in patient education, medication management, and self-care skills training. This RCT aimed to investigate the effectiveness of a specifically designed NDDPI in reducing hospital readmission rates among HF patients.

Methodology

Participants: Patients admitted to a tertiary care center with a primary diagnosis of HF were eligible for participation. Exclusion criteria included cognitive impairment, terminal illness, and inability to provide informed consent. A total of 200 patients were randomly allocated (1:1) to either the intervention group (n=100) or the control group (n=100) using a computer-generated randomization sequence.

Intervention: The NDDPI consisted of the following components:

• Individualized discharge planning: Nurses conducted comprehensive discharge assessments within 24 hours of admission, focusing on identifying patient needs, knowledge gaps, and barriers to self-care.
• Patient education: Nurses provided tailored education sessions covering HF management, medication adherence, symptom recognition and management, dietary and lifestyle modifications, and early warning signs for potential complications.
• Care coordination: Nurses facilitated communication and collaboration with primary care physicians, home health agencies, and social support services to ensure continuity of care after discharge.
• **Telephone ** Nurses conducted follow-up phone calls within 72 hours and 1 week after discharge to assess understanding, address any questions or concerns, and provide additional support.

The control group received standard discharge care as per hospital protocol, which included physician-led discharge planning and routine post-discharge follow-up by a registered nurse.

Outcomes:

The primary outcome measure was the rate of all-cause hospital readmissions within 30 days of discharge. Secondary outcomes included length of stay, healthcare costs, and patient satisfaction with discharge care.

Data Collection:

Data was collected through electronic medical records, patient interviews, and follow-up phone calls. Blinding was maintained for data collection and analysis.

Statistical Analysis:

Data was analyzed using intention-to-treat principles. Chi-square tests and independent samples t-tests were used to compare readmission rates, length of stay, and healthcare costs between groups. Patient satisfaction was assessed using a validated questionnaire and compared using Mann-Whitney U tests.

Results

The baseline characteristics of the intervention and control groups were comparable regarding age, gender, HF severity, and comorbidities. The primary outcome measure revealed a statistically significant difference in readmission rates between the two groups. The NDDPI group had a significantly lower readmission rate within 30 days of discharge compared to the control group (12% vs. 20%, p=0.02).

Secondary outcomes also showed positive results. The NDDPI group had a shorter average length of stay (5.2 days vs. 6.1 days, p=0.01) and lower total healthcare costs associated with the index hospitalization and readmission ($5,200 vs. $6,400, p=0.03). Additionally, patients in the NDDPI group reported significantly higher satisfaction with the discharge planning process compared to the control group (p<0.001).

Discussion

This RCT provides evidence that a nurse-driven discharge plan intervention can effectively reduce hospital readmission rates in patients with HF. The intervention’s success can be attributed to its multi-faceted approach, focusing on patient education, medication adherence, self-care skills training, and care coordination. Nurses play a crucial role in discharge planning, and their expertise in patient education and communication can significantly improve patient understanding and adherence to post-discharge recommendations.